Sterilization acceptance and regret in Thailand

The prevalence of sterilization increased steadily in Thailand from 1969/70 to 1984, but remained unchanged over the period 1984–1987. This paper uses data from the 1987 Thai DHS to examine sterilization acceptance and regret.

The prevalence of sterilization increases with both the number of children and with the age of the woman. Among women with two or more children, there is a positive association between education and wealth, and tubal ligation, but there is no correlation between education and wealth and the percentage of husbands with a vasectomy.

Women whose last delivery was in hospital were more likely to have been sterilized than were women with a home delivery, and among women with a hospital delivery, those who had a cesarean section were more likely to have been sterilized than were women with a vaginal delivery. Both accessibility to medical facilities and medical problems apparently play a role in affecting who gets sterilized.

The percentage of women who reported that they regretted that either they had gotten sterilized or that their spouses had gotten sterilized was 11% but regret was higher in cases in which the wife had had surgery (12%) than in cases in which the spouse had had a vasectomy (8%). This difference persisted even when other variables were introduced to examine the correlates of regret (number of children at time of sterilization, subsequent death of a child, whether sterilization was done at time of CS, residence of the respondent) using multiple classification analysis. Perhaps when women themselves are sterilized, they attribute subsequent problems in health to the operation, whereas such changes cannot be attributed to the vasectomy of their husband.     

Sex work,discrimination, drug use and violence: a pattern for HIV risk among transgender sex workers compared to MSM sex workers and other MSM in Guatemala

ABSTRACT

The risk of HIV infection is higher among transgender women and cisgender men who have sex with men (MSM) compared to the general population due in part to social and contextual factors. This study aimed to determine the prevalence and association of alcohol and drug abuse, discrimination and violence among transgender sex workers compared to cisgender male sex workers and cisgender men who had not received money for sex in Guatemala City. In 2010, transgender women and cisgender men who had had sex with men or transgender women were recruited into a cross-sectional behavioural survey. Among transgender women, 86% received money for sex in the past year. Transgender sex workers were more likely to use drugs and binge drink, three times as likely to be discriminated against and eight times as likely to be forced to have sex compared to non-sex worker men. Male sex workers were twice as likely to use illicit drugs or experience physical violence and six times as likely to experience forced sex compared to non-sex worker men. Transgender and male sex workers would benefit from harm reduction for substance use, violence prevention, response and strategies to mitigate discrimination.     

Symptoms, attitudes and treatment choices surrounding menopause among the Q'eqchi Maya of Livingston, Guatemala

The present study explored symptoms, attitudes and treatments surrounding women's health and menopause among the Q'eqchi Maya of the eastern tropical lowlands of Guatemala. Data were obtained through participant observation, semi-structured interviews, focus groups and plant walks with 50 Q'eqchi community members from the state of Izabal, Municipality of Livingston, including five midwives, five traditional male healers and eight postmenopausal women. Results indicate that the Q'eqchi Maya of Livingston possess their own cultural perceptions of women's health which affect attitudes, symptoms and treatment choices during the menopausal transition. Since discussions of menstruation and menopause are considered cultural taboos among the Q'eqchi, many women mentioned experiencing excessive preoccupation when unanticipated and unfamiliar symptoms occurred. Furthermore, many women suffered from additional hardship when their spouse misinterpreted menopausal symptoms (vaginal dryness, sexual disinterest) as infidelity. Seven of the eight postmenopausal women interviewed indicated experiencing one or more symptoms during the menopausal transition, including headaches, anxiety, muscular pain, depression, and hot flashes. These results differ from the lack of symptomatology reported in previous studies in Mexico, but are in line with the result of menopausal research conducted among other Maya groups from the highlands of Guatemala. Although the Q'eqchi did not use a specific term for "hot flash", three Q'eqchi women used the expression "baja presion" or a "lowering of blood pressure" to explain symptoms of profuse sweating followed by chills, heart palpitations, and emotional instability. The Q'eqchi Maya mentioned a number of herbal remedies to treat menopausal symptoms. Further research on these botanical treatments is needed in order to ascertain their safety and efficacy for continued use.     

Public opinion on and potential demand for vasectomy in semi-rural Guatemala.

In this study of 1,600 men aged 25-50 from semi-rural Guatemala, three-fourths had heard of vasectomy. Among these, 54 per cent approved of it. However, the survey reveals a widespread lack of knowledge regarding the procedure, as well as negative perceptions or doubts about its effect on sexual performance, ability to do hard work, health, and manhood. One-fourth of the respondents who knew of vasectomy and who desired no more children expressed interest in having the operation, a finding which raises questions as to the potential (unrecognized) demand for vasectomy in other developing countries.     

Body Image Satisfaction in Heterosexual,Gay, and Lesbian Adults

Does the prevalence and degree of body dissatisfaction differ among heterosexual and homosexual men and women? Some theorists have suggested that, compared to their heterosexual peers, gay men are at greater risk for body dissatisfaction and lesbians at lower risk. Past studies examining this issue have generally relied on small samples recruited from gay or lesbian groups. Further, these studies have sometimes produced conflicting results, particularly for comparisons of lesbian and heterosexual women. In the present research, we compared body satisfaction and comfort with one’s body during sexual activity among lesbian women, gay men, heterosexual women, and heterosexual men through two large online studies (Ns = 2,512 and 54,865). Compared to all other groups, heterosexual men reported more positive evaluations of their appearance, less preoccupation with their weight, more positive effects of their body image on their quality of life and the quality of their sex life, more comfort wearing a swimsuit in public, and greater willingness to reveal aspects of their body to their partner during sexual activity. Few significant differences were found among gay men, lesbian women, and heterosexual women. Many gay men (42%) reported that their feelings about their body had negative effects on the quality of their sex life, as did some lesbian women (27%), heterosexual women (30%), and heterosexual men (22%). Overall, the findings supported the hypothesis that gay men are at greater risk than heterosexual men for experiencing body dissatisfaction. There was little evidence that lesbian women experience greater body satisfaction than heterosexual women.     

Australian Gay Men’s Satisfaction with Sexual Agreements: The Roles of Relationship Quality,Jealousy, and Monogamy Attitudes

This study examined whether relationship quality, dispositional jealousy, and attitudes towards monogamy were associated with gay men’s satisfaction with the agreements they have in their relationships about extra-dyadic sex. Three types of sexual agreement were examined: closed (no extra-dyadic sex is allowed), monogamish (extra-dyadic sex is allowed only when both members of the couple are present), and open (extra-dyadic sex is allowed). Results from a 2010 survey of 772 gay men in relationships indicated that sexual agreement satisfaction was positively associated with levels of intimacy and commitment for all three types of sexual agreement, but was differentially associated with sexual satisfaction within the relationship, jealousy, and monogamy attitudes as a function of sexual agreement type. Mean levels of sexual satisfaction, jealousy, and monogamy attitudes also differed between types of agreement. These findings provided preliminary evidence that sexual agreement satisfaction may be influenced by different factors depending on the type of agreement, which has useful implications for professionals with gay male clients experiencing dissatisfaction with their agreement or with their relationship more generally.     

A study to assess the prevalence of chronic testicular pain in post-vasectomy men compared to non-vasectomised men

OBJECTIVE: To assess the prevalence of chronic post-vasectomy testicular pain (CPTP) compared to the prevalence of chronic testicular pain in a control population of non-vasectomised men. METHODS: A retrospective postal study of 198 men who had a vasectomy more than 3 years previously at the Palatine Centre to determine the incidence of CPTP, of whom 101 (51%) replied (mean age 40.4 years, range 29-54 years, mean time since vasectomy 46.5 months). A control group of 102 men (mean age 40.2 years, range 28-55 years) who had not had a vasectomy were obtained via patients attending the community family planning clinics or associated general practitioner (GP) services in the same geographical area. RESULTS: Occasional non-troublesome discomfort was reported by 37/101 of the post-vasectomy men compared to 21/102 of the control group. Occasional discomfort which was a nuisance was felt by 10/101 of the post-vasectomy group compared with 3/102 of the control group, and 6/101 in the post-vasectomy group reported pain severe enough to seek medical advice compared to only 2/102 controls. None of the post-vasectomy men regretted having had the operation. CONCLUSIONS: Only 6% of cases (compared to 2% of controls) experienced pain severe enough to seek medical advice in the 3-4-year post-operative period. However, there was a significant difference in the prevalence of occasional testicular discomfort between post-vasectomy men and controls. Mostly these pains were not regarded as troublesome, however men attending for vasectomy counselling should be informed of the possibility of this morbidity.     

Vasectomy: views of Latinos and white men

Vasectomy has gained wide acceptance as a safe, effective, and efficient method of birth control. Knowledge regarding the satisfaction of patients who have undergone the procedure has been well documented. In contrast, there is little data examining the attitude of men in general to the procedure or attempting to interpret these attitudes in a cultural context. Moreover, there appears to be widespread belief by providers that acceptance of the operation is poor among ethnic minorities such as Latinos and blacks. A questionnaire was distributed to 50 white and 50 Latino men at a large county hospital to determine ethnic differences in attitudes toward vasectomy. Only 54 percent of the Latino respondents stated they knew what a vasectomy was compared with 96 percent of the white respondents. Among respondents who knew what a vasectomy was, 50 percent of Latinos and 61 percent of whites stated they would not consider vasectomy in the event that they did not want more children. There was little support for the hypothesis that machismo played an important part in the negative responses by the Latino men or that fears of impotence played a role in the attitudes of both groups. This study suggests that a stronger emphasis on education regarding this procedure should be directed to the Latino male population.     

Probabilities of transition among health states for older adults

Goal: To estimate the probabilities of transition among self-rated health states for older adults, and examine how they vary by age and sex. Methods: We used self-rated health (excellent, very good, good, fair, poor, dead) collected in two longitudinal studies of older adults (mean age 75) to estimate the probability of transition in 2 years. We used the estimates to project future health for selected cohorts. Findings: These older adults were most likely to be in the same health state 2 years later, but a substantial proportion changed in both directions. Transition probabilities varied by initial health state, age and sex. Men were more likely than women to transition to excellent or dead. Women were more likely than men to transition to good or fair health. Although women aged 70 will have more years of life and more years of healthy life than men, they also have more years of unhealthy life, and the proportion of remaining life that is healthy is slightly higher for men. When observed and predicted years of healthy life (YHL) were compared in various subgroups, the YHL of persons with less favorable baseline characteristics was lower than predicted, and vice-versa. Differences, however, were small (about 5%). Conclusions: These transition probability estimates can be used to predict the future health of individuals or groups as a function of current age, sex, and self-rated health. This revised version was published online in June 2006 with corrections to the Cover Date.     

The independent contribution of individual-, neighbourhood-, and country-level socioeconomic position on attitudes towards intimate partner violence against women in sub-Saharan Africa: A multilevel model of direct and moderating effects

We examined associations between country, neighbourhood, and individual socioeconomic position (SEP) and attitudes towards intimate partner violence against women (IPVAW). We applied multivariable multilevel logistic regression analysis on Demographic and Health Survey data for 165,983 women and 68,501 men nested within 7465 communities from 17 countries in sub-Saharan Africa collected between 2003 and 2007. Contrary to expectation women were 34% more likely to justify IPVAW than men. We found that sex moderates associations of individual-, neighbourhood-, and country-level SEP with attitudes towards IPVAW. There was a significant positive interaction effect between sex and education attainment; women with no education were more likely to justify IPVAW than men with no education. Negative sex interaction with household wealth status indicates that differences in attitude are less pronounced among women. Unemployed men were more likely to justify IPVAW. Interaction effects indicate that the association of neighbourhood socioeconomic disadvantage with attitudes was more pronounced among women than among men. The association of country-level SEP with attitudes towards IPVWA was inconclusive. There was some evidence that neighbourhood modified the association between individual SEP and attitudes towards IPV. Also, there was cross-level interaction between country and neighbourhood SEP. Neighbourhood and individual SEP were independently associated with attitudes towards IPVAW. The relationship with country-level SEP was inconclusive. The findings underscore the need to implement public health prevention/intervention strategies not only at the level of individual SEP but also at the neighbourhood level.     

中国已婚育龄妇女性生活质量及相关因素分析

从全国人口与生殖健康调查中获得的含有12035名有偶已婚育龄妇女的随机样本资料进行分析。应答率为89.2％。调查结果显示,已婚育龄妇女在调查时点前一个月内的平均性生活频度为4.73次,城市妇女4.30次,农村妇女4.85次。妇女年龄越轻其平均性生活次数越多。妇女的性观念、性态度与性生活频度有明显关系。调查发现,女方认为可以主动提出性生活要求,而且实际能够做到的已婚育龄妇女其月内平均性生活频度显著多于认为“不可以”的妇女。女方认为可以拒绝男方提出的性生活要求且能够做到的妇女,其平均性生活频度明显少于“很难做到”的妇女。妇女性生活频度与满意程度有一定关系,满意者性生活频度高。而且妇女的年龄越轻,其性生活的满意程度所占的比例越高。妇女在妇科方面的不适程度显著影响她们的性生活满意程度。妇科不适感受越严重,其性生活满意者所占的比例越低。本文采用国家调查随机样本对中国已婚育龄妇女的性生活频度和满意程度进行了分析。该调查填补了我国性调查的一项空白,相信其在我国性学研究史上占有重要地位。     

Evaluation of one-hundred open-ended vasectomies

Open-ended vasectomy was performed on one-hundred men. Sixty-three of them showed up for follow-up six months later. Spontaneous recanalisation had occurred in two. Sperm granuloma without orchialgia was found in 14 out of 59 men (23.9 %). Twenty-one out of the 63 thought their sex life had improved, while 40 thought it was unchanged; only one man mentioned pain during intercourse since vasectomy.     

Revised guideline 'Vasectomy' from the Dutch Urological Association

Vasectomy is a simple and reliable method of contraception. Problems associated with vasectomy include inadequate patient information, complications of the procedure e.g. infection and scrotal bleeding (4-22%), chronic scrotal pain after the procedure (2-5%) and spontaneous recanalisation with return of fertility (0.03-I12%). Later in life a substantial number of men come to regret having a vasectomy, notably those who underwent it at a young age and those without children of their own. After 10 years 2.4% of vasectomised Dutch men have a refertilisation procedure (usually a vasovasostomy) because of the wish for children in a new relationship. Since vasectomy is an elective procedure and not done on medical indication, it requires an extensive informed-consent procedure for the patient. Insufficient information may result in inadequate follow-up, omission of semen analysis, and consequent legal procedures should complications or pregnancy ensue. Clearance after the first semen analysis at 3 months can be given if azoospermia is seen or if less than 100,000 non-motile spermatozoa are present in the ejaculate.     

Sources of social support as predictors of health, psychological well-being and life satisfaction among Dutch male and female dual-earners

We examined whether gender differences in health, psychological well-being, and life satisfaction, can be explained by effects of work-related and nonwork-related sources of social support. The sample consisted of 459 men and women from dual earner families. Men report better health and psychological well-being than women, whereas women report higher life satisfaction than men. Contrary to our expectations, women receive more social support from colleagues than men, while men and women equally receive support from their supervisor. As for the nonwork-related sources of social support, men receive more social support from their spouse, while women receive more social support from relatives and friends. No gender differences exist in the effects of social support. Although men and women differ with respect to the social support they receive from different sources, these differences cannot explain gender differences in health, psychological well-being and life satisfaction.     

Population surveillance for physical violence among adult men and women, Montana 1998

BACKGROUND: Few epidemiologic studies of physical violence or intimate partner violence provide population-based surveillance data. OBJECTIVES: To estimate the prevalence and describe the characteristics associated with physical violence among adult men and women in the past year. METHODS: A random sample of Montana households was contacted via the Behavioral Risk Factor Surveillance System telephone survey in 1998 (N=1804). RESULTS: Five percent of men (39/787) and 3% of women (33/1017) reported experiencing physical violence in the past year. Among respondents reporting physical violence in the past year, women were more likely than men to report that the perpetrator was a current/former partner (58% vs 10%, p/=0.05). Men who reported experiencing physical violence in the past year were more likely to be younger and not to be living with a current partner. Women who reported experiencing physical violence in the past year were more likely to be younger, not currently living with a partner, have no health insurance, and have more days with mental health problems in the past month. CONCLUSIONS: Recent physical violence is common for both men and women; however, the perpetrators, locations, and demographic characteristics differ. Further study is needed to better understand the factors associated with physical violence among men and women in the context of designing and implementing appropriate interventions to reduce violence.     

Sterilization regret among U.S. couples

The 1982 US National Survey of Family Growth included questions aimed at measuring sterilization regret. Of the 8583 couples in the survey who were protected from pregnancy by vasectomy or tubal ligation, 26% indicated they would like to have more children and 10% desire sterilization reversal. The proportion of women who want more children despite sterilization is highest (42%) among those aged 20-29 years, then declines with rising age to a low of 13% among women 40-44 years of age. Of all women who assert they want a reversal, 62% are aged 25-34 years. Blacks comprise 11% of contraceptively sterilized couples in the US but 18% of those who want the procedure reversed; similarly, Hispanics make up 6% of contraceptively sterilized couples but 17% of those expressing a desire for reversal. Significantly higher percentages of Medicaid recipients desire sterilization reversal, although this may reflect the fact that poor women are generally younger. Women who were not currently married were significantly more likely than married women to desire reversal (21% versus 8%). Finally, women who were sterilized before the age of 30 years were significantly more likely than those who were older at the time of the procedure to want another child (33% versus 17%) and to desire reversal (14% versus 6%). It is recognized that the responses to this question are not a good indication of the strength of sterilization regret, and they do not provide an accurate measure of need or potential demand for sterilization reversal. However, these findings do reflect a substantial level of dissatisfaction with sterilization as a means of fertility control. Providers of sterilization services should be aware that 10% or more of their patients may later regret their decision. It is possible that if more acceptable methods of reversible contraception were available, fewer women would resort to sterilization at young ages and the level of regret would be reduced.     

Sex in Australia: attitudes towards sex in a representative sample of adults

OBJECTIVE: To describe social attitudes towards sex of Australian adults and correlates of a scale of sexual liberalism. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1% (69.4% men, 77.6% women). Respondents were asked about their agreement with nine attitude statements. Factor analysis and examination of internal consistency resulted in a six-item scale of liberalism. Correlates of attitude statements and the liberalism scale were examined. RESULTS: Most people agreed that premarital sex was acceptable, that oral sex was considered 'sex', that sex was important for a sense of well-being and that extramarital sex was unacceptable. Men were more likely (36.9%) to disapprove of sex between two men than women were to disapprove of sex between two women (25.1%). Higher levels of education were associated with increased liberalism for men and women, as was speaking English at home, identifying as homosexual or bisexual, vaginal intercourse before age 16, having had more than one sexual partner in the year before interview, having had heterosexual anal intercourse, having no religion or faith, smoking tobacco, and drinking more alcohol. CONCLUSION: Sexual attitudes of Australians largely support a heterosexual paradigm with no sex outside the relationship. High levels of approval of premarital sex are consistent with decreasing age of first intercourse in Australia. Higher levels of liberalism were associated with greater sexual adventurism and health risk taking.     

Attitudes about sex and marital sexual behavior in Hai Duong Province, Vietnam

This study examines attitudes concerning sexual relations outside marriage and levels of marital sexual activity using data from married individuals from Hai Duong Province collected in 2001. Among individuals who live in urban areas, have more schooling, and were married after the late 1980s, acceptance is growing concerning intimate behavior without marital commitment and having sex with a future spouse. Schooling, urban residence, and recent marriage have stronger associations with less conservative attitudes among men than among women. Even among younger and better-educated respondents, acceptance of premarital and extramarital sex generally remains below a majority. The reported level of premarital sex is higher among men than among women, and lower than available estimates from other parts of Asia and the developing world. The reported level of sexual activity within marriage in Hai Duong Province is similar to that observed elsewhere, including Thailand and the United States. The incidence of sexual activity declines with age, and at all ages men are more likely than women to report having sex with their spouse. The implications of these gender differences in sexual attitudes and behavior are considered.     

Absence from Work following Vasectomy

A study of 90 patients undergoing day case vasectomy revealedthat 46.2 per cent took time off work following surgery. Themain reason for absence was pain or discomfort and patientswere more likely to take time off if their operation was atthe beginning of the week than at the end. Methods of reducingthe man hours of work lost are discussed. ³Requests for reprints should be addressed to: P. E. Randall FRCS, Accident and Emergency Department, Hope Hospital Eccles Old Road Salford M6 8HD, Manchester.     

输精管绝育术后并发症与远期安全性

输精管切除术是一种安全、有效、简便的男性绝育手术,也是一种重要的避孕选择。血肿和感染是最常见的早期手术并发症,发生率分别低于1%和2%。少数人手术后发生慢性阴囊或睾丸疼痛或不适,需要手术治疗者＜1%。报告的输精管切除术失败率为0～2%。超过60%的男子术后发生循环抗精子抗体,除泌尿生殖道感染或炎症风险有短期升高外,多项大规模流行病学研究证实,输精管切除术不增加远期健康风险,包括心血管疾病、免疫相关疾病或前列腺癌。